BMJ 1995;311:1113-1114 (28 October)

Editorials

Endarterectomy for asymptomatic carotid artery stenosis

Reasonable doubt justifies randomisation

European and North American clinicians have always differed in their management of carotid artery disease.1 Carotid endarterectomy is one of the commonest vascular procedures in North America, with over 360 operations per million population being performed each year.1 Meanwhile, despite the fact that the first carotid reconstruction was performed in Britain,1 selection for the procedure in Europe has been sporadic. British data for 1993-4 confirm that fewer than 40 carotid endarterectomies are performed per million population per year (personal communications from Department of Health, England; NHS Information and Statistics Division, Scotland; and Department of Health and Social Services, Northern Ireland, 1995).

Two major multicentre trials, the North American symptomatic carotid endarterectomy trial and the European carotid surgery trial, both published in 1991, have helped to define the role of carotid endarterectomy in patients with symptoms, such as transient ischaemic attacks and non-disabling strokes.2 3 In symptomatic patients . . . [Full text of this article]


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This article has been cited by other articles:

  • Whitty, C J M, Sudlow, C L M, Warlow, C P (1998). Investigating individual subjects and screening populations for asymptomatic carotid stenosis can be harmful. J. Neurol. Neurosurg. Psychiatry 64: 619-623 [Abstract] [Full text]  
  • Kase, C. S, Wolf, P. A (1996). Endarterectomy for asymptomatic carotid artery stenosis. BMJ 312: 442c-443 [Full text]  
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